Do social contexts impact tic expression?
Community Summary of: Social Context is a Cue for Tic Reduction in Clinical Settings
Authors of the article in the Journal of European Child & Adolescent Psychiatry: Brianna CM Wellen, Grace Bacon, David Schneck, Emily Wilton, Alison Pryor, IaOom Khang, Kelvin Lim, Kevin J. Black, Erjia Cui, Mark B. Fiecas, Christine A. Conelea
Published online: August 5, 2025
Community summary posted on September, 12, 2025
Word count: 565
Reading grade level: 11
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Why does this study matter?
Studies have found that for different people, tics can vary in different settings. Researchers think this is because the brain learns from environmental responses to tics, and different people have different learning histories. Learning histories depend on the environments people have experienced.
Tics can even change in severity depending on who is in the room, including in healthcare settings. This might make assessment and diagnosis of tics difficult. Most strategies rely on what a clinician sees during a session and on what patients report, which may not fully represent their experience.
To improve our understanding of tics in healthcare settings we looked at differences in tic frequency and type of tics. We compared between when participants were with a clinician compared to when they were alone and ticcing freely, and when they were alone and given instructions to try to stop their tics. We also wanted to know what clinicians might be missing.
What happened?
Thirty-nine youth ages 12-21 participated in a large randomized controlled trial. For the part of the trial that is relevant to this study, they participated in four videotaped conditions. These were two interviews with the clinician (one focused on tics and one not), sitting alone and instructed to tic freely (Free to tic condition), and sitting alone and asked to try to stop their tics (tic control condition). They participated in these conditions before and after behavior therapy for tics.
The clinical interview focused on tics is called the Yale Global Tic Severity Scale (YGTSS), and it is a measure commonly used in tic studies. Clinicians combine participant reports of tics over the past week with what they see in their session. Then they rate tic severity They look at number, frequency, intensity, complexity, interference, and impairment.
To get a measurement of tic frequency and type from the videos, researchers coded each video by hand, marking when a tic happened and what type of tic it was.
What did this group learn?
Researchers found that for over 95% of the participants, there were more tics in the free to tic condition than when the clinician was present. Also, most participants even had significantly more tics in the alone tic suppression condition than when they were with the clinician talking about their tics during the YGTSS. This finding surprised the researchers because talking about tics has been thought to increase tics.
These results suggest that the social context of a clinician being present may increase tic suppression, whether it is automatic or intentional. This may be a strategy that participants have learned over time and has become more automatic.
When researchers looked at tic frequency and type at the beginning of treatment compared to the end, they found that tics decreased significantly across treatment both in the alone conditions and the clinician conditions. There was more decrease in tics in the alone conditions.
Assessment and diagnosis of tics should include observation of tics without a clinician or others present. Also, it may be helpful for patients to bring in video recordings of tics. Integrating direct observation with measurement of self-perception of tics may help.
What can our research team do next?
Future studies could add continuous measures of these situations to see patterns for individual participants. They should examine these situations across longer periods, as we did not have the statistical power to conduct follow-up analyses.
How can you find out more?